The two chambers of Congress are expected to meet later this month to figure out how to reconcile government spending legislation.
Proposals from both the House and Senate find savings by nibbling into the massive government-funded health insurance programs—Medicare and Medicaid.
Healthcare organizations in New Hampshire tend to agree that the costs of these programs are out of control.
But they disagree with lawmakers about how to solve the problem.
New Hampshire Public Radio’s Kerry Grens reports.
Groups representing hospitals, doctors, and health clinics agree: the House version of how to trim government spending is less desirable.
The bill focuses on Medicaid—the three hundred billion dollar a year health insurance program for the poor.
The House bill trims about ten billion dollars from the growth of Medicaid spending over the next five years.
Representatives Charles Bass and Jeb Bradley voted for the bill.
Bass says the growth reductions translate into a fraction of a percent in overall spending.
And it’s a small step in the right direction.
Bass: Everybody—republican, democrat, liberal, moderate—anybody who is concerned about the fiscal integrity of this country over the next 50 years needs to understand that we will have to address entitlement reform.
Tess Kuenning from Bi-State Primary Care agrees Medicaid could benefit from going on a diet.
Bi-State represents the state’s Community Health Centers, which serve a large number of people on Medicaid.
Kuenning: our support would be for some changes to the Medicaid program, but no changes that would really affect the level of services or the providers.
And that’s why Kuenning doesn’t support the House bill.
It allows states to more easily exclude services that Medicaid would cover.
Kuenning: For instance dental services, screenings, any of the chronic diseases in terms of diabetes visits, those are all dictated under the state plan and any one of those things could change.
So while community health centers might continue to provide any of these medical services, the state could decide it wouldn’t reimburse for them.
In the House bill states would also be allowed to introduce co-pays and premiums.
Medicaid patients now get everything for free.
Tom Bunnell, a health policy analyst at Franklin Pierce Law School, says that co-pays and premiums could be disastrous for beneficiaries.
Bunnell: either vulnerable folks will go without care, or that the implementation of premiums will force them to drop ff the program because they can’t afford the premiums.
According to the American Hospital Association, initiating co-pays and premiums would save about three billion dollars.
Fifty five million of that is expected to come from emergency room co-pays.
But Kathy Bizarro from the New Hampshire Hospital Association says co-pays backfire on hospitals.
Bizarro: The onus will be on the beneficiary to pay two dollars three dollars five dollars whatever the states decide would be the co-pay and it would be up to the hospital to try to get that money from the beneficiary, which is very difficult, and in most instances it would cost the hospital more trying to get it than if they would receive it.
But the House proposal doesn’t force states to impose premiums and co-pays, it merely gives them the option.
And State Health and Human Services Commissioner John Stephen approves of the idea that states deserve more authority to design their Medicaid programs.
Stephen: if states are given more flexibility that states will be able to run and manage their programs through the most efficient way and also provide good quality services.
The House bill estimates such efficiency could save the Medicaid program four billion dollars over the next five years.
Stephen says there is no risk that those on Medicaid will lose necessary medical care because the legislature wouldn’t let that happen.
The House bill also includes a pay cut for doctors who treat patients with Medicare—the health insurance program for people over sixty five.
According to the New Hampshire Medical Society, if the provision remains, doctors’ reimbursements from Medicare will fall twenty percent in the next five years.
Palmer Jones from the Society estimates the payment reductions to New Hampshire doctors alone would save Medicare about eleven million dollars a year, and trim a physician’s income by about four thousand.
But it could also do a lot more than that.
Jones says doctors are already refusing to take on any more Medicare patients in anticipation of the pay cut.
Jones: We are now getting calls from Medicare recipients who are just turning 65 for their Medicare requirement and they are not being able to get in to see physicians.
The Medical Society and the other groups are lobbying Congress to find other ways of reducing spending on Medicare and Medicaid.
Yet there are some aspects of the House bill many are pleased with.
For instance, two point five billion dollars might be saved by tightening Medicaid eligibility rules to restrict people from reducing their assets in order to meet the low income requirements.
The Senate bill also seeks to scale back Medicaid and Medicare growth by about ten billion dollars over the next five years.
But companies that participate in the health insurance programs would carry the brunt of those reductions, rather than changing services or increasing the cost to beneficiaries.
Under the Senate bill, Medicaid would seek the six billion dollars in drug discounts from the pharmaceutical industry.
And Medicare would eliminate what it considers overpayments to managed care groups.
Tess Keunning from Bi-State Primary Care calls the Senate’s plan a more reasonable approach to an inevitable spending reduction.
But Keunning says she doesn’t know whether any stab at slowing Medicaid will reach the heart of making it sustainable.
SOQ
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